It is the field of research and clinical applications focused on the repair and regeneration of cells, tissues or organs in order to restore a damaged function. New techniques in regenerative medicine using the “Stromal Vascular Fraction” (SVF) of the perichondrium of the patient's own atrial cartilage [1].

The vascular stromal fraction is formed by different cells, with the capacity to regenerate those tissues damaged both by trauma and by the aging and cellular wear. In the SVF of the perichondrium of the auricular cartilage, we find large numbers and viability of cells to generate new adipose tissue and blood vessels as well as produce growth factors that and to the formation of the vascular network [2,3].

CHARACTERISTICS OF THE SVF

·         Ability to differentiate in different lineages and are very useful for tissue replacement therapy (refers to multipotentiality) [4,5].

·         They can be administered directly in the affected area where tissue regeneration is attempted or systemically/intravenously [6].

·         They can secrete soluble factors that promote the paracrine effect and immunomodulators that facilitate the therapeutic effects [7,8].

·         They are immunoprivileged that allows a minimal immune reaction due to the lack of expression of class II immunocompatibility. They present receptors and can be directed or migrate to the places of the lesion [9].

·         When fresh ADSCs are isolated, a non-cultured heterogeneous population is obtained, which are the SVF (Vascular Stromal Fraction) cells with therapeutic qualities that are better adapted to the different clinical scenarios.

The principle on which this technology is based is to use healthy counterpart connective tissue of the same patient processed with KIT to regenerate its own damaged tissue.

The affinity of the donor and recipient tissue used contributes a high differentiation and potentiality obtaining as a result a great cellular regenerative efficiency.

The lumbar disc herniation is the result of a protrusion or prolapse of the nucleus pulposus of an intervertebral disc in the spinal canal, after perforation and partial or complete destruction of the posterior part of the annulus fibrosis. When this happens, the nerve root is compressed by the nucleus pulposus, causing various symptoms, such as pain in the lower limb, back pain and feeling of wheezing.

CLINICAL CASE

We know the different treatments of the pathology of the Lumbar disc herniation; we performed the first lumbar disc pathology treatment with the tissue micrograft technique in the nucleus pulposus, in a patient with a contained disc Herniation (fibrous ring without rupture).

Patients aged between 18 and 70 years, with degenerative disease: (Disc prothesis: black disc) with predominant back pain after conservative treatment (physical and medical) for more than 6 months. Patients must have a fibrous ring capable of supporting the cellular implantation; as shown by the MRI image (exclusion of extruded material).

The technique consists:

With local anesthesia a 2.5 mm punch of the auricular cartilage (Figure 1), containing articular cartilage perichondrium, is obtained (Figure 2).

DISCUSSION

The main treatment for lumbar disc herniation is conservative and the response is approximately 80%. Conservative treatment includes rest, bed rest, pharmacological treatment (e.g. non-steroidal anti-inflammatory drugs, corticosteroids and muscle relaxants), use of a corset, traction therapy, thermotherapy, epidural block, nerve root block and physiotherapy. Between 20% and 50% of the patients, approximately, are tributaries of surgical treatment (when no improvement is observed with a conservative treatment) [10].

To reduce the invasiveness of surgical procedures, new therapeutic approaches have emerged, including chemonucleolysis, percutaneous nucleotomy, percutaneous laser disc decompression and microendoscopic discectomy.

Degenerative disc disease (DDD) is a condition associated with the degeneration of one or more of the discs in the spine. DDD can cause severe chronic pain in the back at the level of the disc region and it can radiate to the hips and legs. There may be severe inflammation and degeneration of the fibrocartilage.

The perichondrium of the auricular cartilage is a new therapy for patients with degenerative disc disease. SVF injected directly into the disc can reduce inflammation and promote healing. SVF is an attractive therapeutic method since the collection process is safe and the cells are readily available in generally large quantities.

Clinical studies have demonstrated the safety and feasibility of using SVF in patients with degenerative disc. No major safety problems were observed and the procedures were well tolerated in all patients. In addition, patients showed statistically significant improvements in several parameters including flexion, pain classifications, VAS, PPI and questionnaires in abbreviated form. Although ODI and BDI did not show statistically significant changes due to the low number of subjects in the trial, the data allow verifying positive trends. In addition, most patients reported improvements in their Dallas Pain Questionnaire scores.

CONCLUSION

This percutaneous technique of regenerative medicine is beginning in our unit and our desire is to carry out prospective studies to make the comparison with other known techniques of the percutaneous type and see if the results are significant to be used within the existing techniques.

1.       Moseley TA, Zhu M, Hedrick MH (2006) Adipose-derived stem and progenitor cells as fillers in plastic in reconstructive surgery. Plast Reconstr Surg 118: 121S-128S.

2.       Matsumoto D, Shigeura T, Sato K, Inoue K, Suga H, et al. (2007) Influences of preservation at various temperatures on liposuction aspirates. (Plast Reconstr Surg 120: 1510-1517.

3.       Suga H, Matsumoto D, Inoue K, Shigeura T, Eto H, et al. (2008) Numerical measurement of viable and nonviable adipocytes and other cellular components in aspirated fat tissue. Plast Reconstr Surg 122: 103-114.

4.       Charles-de-Sá L, Gontijo-de-Amorim NF, Maeda Takiya C, Borojevic R, Benati D, et al. (2015) Anti-aging treatment of the facial skin by fat graft and adipose-derived stem cells. Plast Reconstr Surg 135: 999-1009.

5.       Gimble JM, Guilak F (2003) Adipose-derived adult stem cells: Isolation, characterization and differentiation potential. Cytotherapy 5: 362.

6.       Hauner H (1989) Promoting effect of flucocorticoids on the differentiation of human adipocyte precursor cells cultured in a chemically defined medium. J Clin Invest 84: 1663.

7.       Katz AJ, Tholpady A, Tholpady SS (2005) Cell surface and transcriptional characterization of human adipose-derived adherent stromal (Hadas) cells. Stem Cells 23: 412.

8.       Miranville A (2004) Improvement of postnatal neovascularization by human adipose tissue-derived stem cells. Circulation 110: 349.

9.       Mitchel JB, Mcintosh K, Zvonic S, Garret S, Floyd ZE, et al. (2006) Immunophenotype of human adipose-derived cells: Temporal changes in stromal-associated and stem cell-associated markers. Stem Cells 24: 376.

10.    Rehman J (2004) Secretion of angiogenic and antiapoptotic factors by human adipose stromal cells. Circulation 109: 1292-1298.